EURURO Vol. 72 No. 5

801 860

Guidelines
Prognostic Performance and Reproducibility of the 1973 and
2004/2016 World Health Organization Grading Classification
Systems in Non–muscle-invasive Bladder Cancer: A European
Association of Urology Non-muscle Invasive Bladder Cancer
Guidelines Panel Systematic Review
Viktor Soukup Otakar Cˇapoun Daniel Cohen Virginia Herna´ndez Marek Babjuk
Max Burger Eva Compe´rat Paolo Gontero Thomas Lam Steven MacLennan
A. Hugh Mostafid Joan Palou Bas W.G. van Rhijn Morgan Roupreˆt , Shahrokh F. Shariat
Richard Sylvester Yuhong Yuan Richard Zigeuner
a Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University in Praha, Praha, Czech Republic; bDepartment of Urology,
Royal Free London NHS Foundation Trust, London, UK; c Department of Urology, Hospital Universitario Fundacio´n de Alcorco´n, Madrid, Spain; dHospital
Motol and Second Faculty of Medicine, Charles University, Department of Urology, Prague, Czech Republic; e Department of Urology, Caritas-St. Josef Medical
Center, University of Regensburg, Germany; f Department of Pathology, Hoˆpitaux Universitaires de l’Est-Parisien HUEP, Assistance Publique Faculty of
Medicine Pierre et Marie Curie, Institut Universitaire de Cancerologie GRC5, University Paris 6, Paris, France; g Department of Surgical Sciences, Urology,
University of Turin, Turin, Italy; h Academic Urology Unit, University of Aberdeen, Scotland, UK; i Department of Urology, Aberdeen Royal, 12 Infirmary,
Aberdeen, Scotland; j Department of Urology, Royal Surrey County Hospital, Guildford, UK; k Department of Urology, Fundacio´ Puigvert, Universitat
Auto`noma de Barcelona, Barcelona, Spain; l Department of Urology, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The
Netherlands; m Department of Urology, Groupe Hospitalier Pitie´—Salpeˆtrie`re, Assistance Publique Hopitaux de Paris, Faculty of Medicine Pierre et Marie
Curie, Institut Universitaire de Cance´rologie GRC5, University Paris 6, Paris, France; nDepartment of Urology, Vienna General Hospital, Medical University of
Vienna, Vienna, Austria; oEAU Guidelines Office Board, European Association of Urology, The Netherlands; pDepartment of Medicine, Health Science Centre,
McMaster University, Hamilton, Ontario, Canada; q Department of Urology, Medizinische Universita¨t Graz, Graz, Austria
ava ilable at
journal homepage:
Article info
Article history:
Accepted April 12, 2017
Associate Editor:
James Catto
Keywords:
Non–muscle-invasive bladder
cancer
Grade
1973 World Health Organization
classification
Abstract
Context: Tumour grade is an important prognostic indicator in non–muscle-invasive
bladder cancer (NMIBC). Histopathological classifications are limited by interobserver
variability (reproducibility), which may have prognostic implications. European Asso-
ciation of Urology NMIBC guidelines suggest concurrent use of both 1973 and 2004/2016
World Health Organization (WHO) classifications.
Objective: To compare the prognostic performance and reproducibility of the 1973 and
2004/2016 WHO grading systems for NMIBC.
Evidence acquisition: A systematic literature search was undertaken incorporating
Medline, Embase, and the Cochrane Library. Studies were critically appraised for risk
of bias (QUIPS). For prognosis, the primary outcome was progression to muscle-invasive
or metastatic disease. Secondary outcomes were disease recurrence, and overall and
cancer-specific survival. For reproducibility, the primary outcome was interobserver
variability between pathologists. Secondary outcome was intraobserver variability
(repeatability) by the same pathologist.
* Corresponding authors. Department of Urology, General TeachingHospital and 1st Faculty ofMedicine,
Charles University in Praha, Praha, Czech Republic. Tel. +420 224967847; Fax: +420 224967102.
E-mail addresses: (V. Soukup), (O. Cˇ apoun).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.